Jeff VanderMeer

How I Became One of Dr. Lambshead's Medical Assistants for Three Years: The Sordid Story Behind The Thackery T. Lambshead Pocket Guide to Eccentric and Discredited Diseases, edited by Jeff VanderMeer and Mark Roberts
By Jeff VanderMeer

"Mentioned in whispers for decades; burned in Manchuria; worshipped in Peru; the only book to be listed on the Vatican's Index Librorum Prohibitorum twice, for emphasis; available again at last, in this definitive edition. Welcome to the Lambshead Guide. Disease-mongers, shudder." -- Dr. China Mieville

When people ask me "Jeff, how did you come up with the crazy idea for a fake disease guide?" I always tell them two people are to blame: Dr. Thackery T. Lambshead and, perhaps more importantly, Allen Ruch, creator of The Modern Word web site.

Allen's e-mail moniker is "The Great Quail." One day toward the end of 2000, the Great Quail happened to include a P.S. that read: "I think I have contracted Mad Quail Disease."

Mad Quail Disease. Suddenly, the image of a chapbook of odd fictional diseases materialized in my brain.

"No," I told myself. "That's just too weird."

A week later, the image hadn't faded -- it had, if anything, gained strength and legitimacy.

Soon, I had a nascent publisher and co-editor in Mark Robert and his London-based Chimeric Creative Group. The idea at the time was a short collection of diseases, something a smaller publisher like Chimeric could handle.

But a funny thing happened on the way to publication. What was supposed to be a little chapbook of fake diseases slowly but surely, over a period of three years, turned into a 320-page medical monstrosity, complete with footnotes, fake history, reminiscences, and more than 70 illustrations.

How did it happen?

We had created a monster in the persona of Dr. Thackery T. Lambshead, an octogenarian physician, now retired to Wimpering-on-the-Brink, who had spent his life traveling the globe in search of the most exotic diseases known to humankind. And then, most unwisely, we gave him a medical guide, The Thackery T. Lambshead Pocket Guide to Eccentric & Discredited Diseases (now in its 83rd edition). The Guide had a long and glorious history long before we had any diseases to populate it with.

But perhaps the worst thing Mark and I did was to send out the guidelines to about a dozen writers, hoping that at best maybe half would respond with a submission.

Perhaps we shouldn't have stressed the "fun" part of the project, because we received submissions from everyone we had solicited work from, some of which we had to reject. And not only did we receive submissions, but the writers involved suggested other writers to invite...and invite begat invite begat invite...until it became clear we had a small book on our hands, not a chapbook at all.

"It really was an organic type of thing, a sort of e-mail-spread meme," Mark recalled when I asked him about it.

By this time, we had great work in hand from Michael Moorcock, Kage Baker, Liz Williams, Rikki Ducornet, Brian Evenson, China Mieville, Alan Moore, and many others. We had also solicited reminiscences from writers of their doctor personas working with Dr. Lambshead in the field. Stepan Chapman, a Philip K. Dick Award winner whose work has appeared in McSweeney's, not only contributed a reminiscence -- he wrote us a secret history of the 20th century as seen from the perspective of the Guide.

We had no choice but to search for a larger publisher. Eventually, Night Shade Books not only made an attractive offer, but also displayed the kind of enthusiasm we thought the book would need for any marketing efforts to be successful.

Clearly, our little book had become a Big Book. But not only had it become a Big Book, it had become a Real Medical Guide -- in terms of the amount of work required to edit it.

"I've never seen anything like it in terms of the prep work required," Mark wrote to me via e-mail during the midst of the worst of it. "It's madness!"

We had to deal with issues of medical authenticity (for which we relied on family physician Mark Shamis); standardization of references in each of the 65 contributors' entries; addition of cross-references; several layers of copy-editing; and much else. Late at night, going through the text yet one more time, I began to lament that after the project was over, I'd have put in as much work as if I'd co-edited a real medical guide, but still wouldn't have the credentials to edit a real one!

Yet even then, we weren't finished. John Coulthart had agreed to do the design of the book. John is one of the world's best book designers, his work for Savoy is legendary in the United Kingdom. He's a very visual designer who, when necessary, will combine elements of graphic novel design into his books. We thought he'd be ideal to add illustrations, fake covers of prior editions, and anything else we'd need to make the Guide authentic.

So it shouldn't have come as any surprise that the first e-mail John sent to us once he started on the project was: "I'm determined to find or create an illustration for every disease in the book." Mark and I had thought that there might be a few illustrations, but had no idea John would become as obsessed with the Guide on the graphic side as we had on the editorial side.

Soon John was sending us pages with "bloodstains" gray scaled over the page numbers; a number of mockup pages of disease entries with stunning accompanying illustrations; a table of contents that looked like a medical chart; and a series of stunning fake covers. Not only was he creating an amazing look-and-feel for the book, he went ahead and wrote his own disease, "Printer's Evil," which is one of the highlights of the book.

"The challenges of working on the disease guide were myriad," John would say later. "Not least of which was working on fleshing out my own ideas while incorporating yours and Mark's."

I can't say it wasn't without strife. There were a lot of late nights emailing back and forth. There weren't necessarily arguments per se -- more that both editors and the designer loved the project so much that over time the project changed yet again, metamorphosing into something even better than it had been before.

The moment I knew I personally had gone around the bend on the project, succumbing to what Neil Gaiman calls "Diseasemaker's Croup," occurred on what we all call "The Borges Entry." A New Orleans writer, Nathan Ballingrud, had created a disease called "The Malady of Ghostly Cities" that didn't fit the rest of the Guide. In this disease, people turn into whole cities in barren, remote locales, their essence contained in libraries in the heart of the cities. The entry was so good that we had to find a way to include it. So we decided that Dr. Lambshead had met Jorge Luis Borges during his travels, and influenced Borges to produce a little-known book of metaphysical diseases, only available in an Argentine version, in Spanish.

One night, well into pre-production, I realized, with a certainty that bordered on madness, that we needed not only the English translation from the Spanish, but the original Spanish version as well. I quickly sent out an e-mail to John and Mark, who, to their credit, took it in stride, and soon we'd convinced Gabriel Mesa, a Spanish-speaking lawyer in New York City, to go along with it all without asking "Are you all crazy?" Within a few weeks, we had the "original" Spanish version of Ballingrud's disease. We also had John's incredibly creative covers of the Argentine edition, and a subsequent cheap English-language paperback of The Book of Metaphysical Diseases that mysteriously had not included Dr. Ballingrud's contribution.

Meanwhile, new text had to be created every so often to replace old captions or to make the whole concept more plausible. Sometimes it was a bio note for Lambshead himself -- who Mark and I were too close to for us to write it ourselves --and sometimes it was a bit of introductory text for a disease from the "Autopsy" section (examples from prior editions).

In such cases, we bounced ideas off of Stepan and John, and also brought in Michael Cisco, a New York City-based writer who specializes in bizarre Burroughs-meets-Beckett work.

Slowly, the Guide took shape. After more than four months of pre-production, the Beast, as I think we had all come to call it, was ready to be sent to the printer for production of bound galleys. (All through this time, Mark was fine-tuning the excellent Web site he had created for the Guide to help trigger pre-orders: http://www.lambsheadguide.com.)

Of course, at this point, the fear set in. Looking over the finalized layout, with titles of diseases like "Motile Snarcoma," "Extreme Exostosis," and "Bone Leprosy," I think both Mark and I thought, "Oh my god...we've just sent a 320-page book to press that may be the weirdest anthology ever produced in the history of English literature!"

Was it all commercial suicide? Was it the biggest folly since the French built a palace in the shape of a huge elephant?

Luckily, that has not turned out to be the case. We waited on pins and needles for the initial pre-pub reviews, and were rewarded with some glowing notices:

Publishers Weekly: "An often amazing book. Sure to delight the discerning reader!"

The Complete Review: "A lot of care has been put into this volume, and it is a fun book to make one's way through. Fun and cleverness can be found at every turn. Enjoyable!"

San Francisco Bay Guardian: "This anthology is so demented and funny it must be read to be believed!"

It's early days, of course, but with Ingrams taking a large initial order; over a hundred reviews forthcoming; publications like The Village Voice running articles on the Guide; a slew of advertisements in everything from Locus Magazine to Rain Taxi to Arthur to The Placebo Journal; along with enthusiastic endorsements from our contributors, we think we've got a shot at a successful launch.

Least anyone think the Guide makes fun of the ill, I should point out that several of the diseases in the Guide are serious, for balance, and because we are sensitive to the issue. We've been very happy to see the great reaction from medical personnel, too, for whom a book like this is a welcome relief from daily stress.

The success of the project, though, has been due to, as Mark puts it, "taking it seriously. Without our totally committing to the idea of the personage of Dr. Lambshead, the funny bits wouldn't be quite as funny."

Sometimes people ask me why we did this anthology. The answer, really, is because it's imaginative and it involves an advance sense of play. Because we think it will delight readers, and make them think at the same time.

Besides, Dr. Lambshead made us do it.